Telehealth Across State Lines for Therapists: What You Need to Know
Table of Contents
Understanding the Landscape
The rapid expansion of telehealth has fundamentally changed how therapy is delivered — but it hasn’t changed where therapy is legally considered to occur. In almost every U.S. jurisdiction, a therapy session is legally “taking place” wherever the client is physically located at the time of the session. That means if you’re a Vermont-licensed therapist providing telehealth to a client who’s physically in Massachusetts, you are technically practicing in both states — and must be authorized to do so in each.
This reality creates one of the most complex regulatory challenges in modern mental health care: interstate practice.
While most therapists understand their home state’s licensure requirements, far fewer realize that a single telehealth session with an out-of-state client — even one who has simply crossed a border for college or work — can expose them to regulatory risk. Each state defines “practice,” “telehealth,” and “authorization” differently, and some boards enforce these distinctions actively.
The Patchwork of State Rules
Broadly, states fall into three categories:
- Full Licensure Required – The majority of states (e.g., California, New York, Illinois) require that you hold a full in-state license before you can provide therapy to anyone located within their borders.
- Telehealth-Specific Registration or Limited Licensure – A small but growing number of states (e.g., Florida, Vermont, Colorado starting 2026) have created special “telehealth registration” pathways that allow out-of-state clinicians to offer virtual services without obtaining a full license. These registrations typically include limits on client numbers, duration, or practice scope.
- Interstate Compact Participation – Many professions are adopting interstate compacts — such as PSYPACT for psychologists, the Counseling Compact for LPCs and LMHCs, and the Social Work Compact (in development). These compacts allow eligible clinicians to practice across member states more seamlessly.
However, it’s important to note that compacts don’t automatically grant universal practice rights; they require you to apply, maintain good standing, and often practice only within compact states that have implemented the necessary legislation and infrastructure.
Why This Matters for Clinicians
For mental health professionals — especially those working with clients who move, travel frequently, or split residency — knowing these distinctions is essential. A client who begins therapy in your home state but later moves across a border could suddenly shift your legal and ethical obligations. Even well-intentioned cross-state care can trigger violations if the therapist lacks the required authorization.
Risks include:
- Board discipline for unlicensed practice
- Ethical complaints for exceeding scope of authorization
- Loss of insurance coverage or reimbursement
- Voiding of malpractice insurance protections
States with Specialized Telehealth Pathways
A few states stand out for creating alternative routes to practice without full in-state licensure.
- Florida maintains a formal Out-of-State Telehealth Provider Registration, allowing qualified practitioners licensed elsewhere to see Florida-based clients remotely. This registration is renewable and subject to several compliance conditions, including liability insurance and background checks.
- Vermont offers a Telehealth Registration pathway that lets out-of-state professionals see a limited number of Vermont clients (for example, continuity-of-care or short-term relationships) without full licensure, provided they meet eligibility and disclosure standards.
- Colorado, beginning in 2026, will implement a Telehealth Provider Registration that enables out-of-state clinicians to practice virtually with Colorado residents under certain conditions — part of a broader trend toward flexibility.
Other states, including Utah, Arizona, and Delaware, are actively exploring similar models or compact participation expansions.
Key Takeaways
- Always check the client’s location before each session. Jurisdiction is tied to where the client is physically present — not where their home address is or where the clinician practices.
- Maintain awareness of both licensure and compact options. These may differ by profession (LCSW, LMFT, LPC, Psychologist, etc.).
- Document informed consent carefully. Many states require telehealth-specific consent, including acknowledgment of location, technology, and emergency procedures.
- Stay current. State laws evolve quickly, especially post-COVID, as legislatures modernize telehealth statutes.
How to Use This Guide
The summaries below provide plain-language explanations of how each U.S. state handles out-of-state teletherapy. Each section contains a direct link to an authoritative source — typically the Center for Connected Health Policy (CCHP), which maintains the most comprehensive and regularly updated national database of telehealth laws.
This resource is designed to help therapists, supervisors, and practice owners navigate compliance and risk while continuing to serve clients ethically and effectively in a borderless, digital world.
If you are unsure whether your license qualifies under a compact, or if your professional board has implemented a new rule, always confirm directly with your state licensing board before beginning interstate telehealth work.
Find Your State
Alabama
Therapists who want to provide telehealth to clients located in Alabama generally need to hold an Alabama license or another approved authorization. Each professional board sets its own standards, so check your specific board’s rules for telepractice and compact eligibility.
Source: CCHP Alabama
Alaska
If your client is physically located in Alaska, you must typically be licensed in Alaska to provide teletherapy. There are no broad reciprocity agreements, but Alaska supports telehealth as long as standards of care are met.
Source: CCHP Alaska
Arizona
Arizona has been proactive about telehealth expansion. While the state is supportive of virtual care, therapists still need an Arizona license or another approved pathway to treat clients located in Arizona.
Source: CCHP Arizona
Arkansas
To provide therapy to clients in Arkansas, you must be licensed or otherwise authorized to practice in that state. Arkansas applies the same ethical and professional standards to telehealth as to in-person sessions.
Source: CCHP Arkansas
California
If your client is in California, you must hold a valid California license to provide therapy. California also allows a limited 30-day temporary practice period per year for out-of-state clinicians to continue seeing existing clients who are temporarily in California.
Sources:
Board of Psychology Telehealth FAQ
Colorado
Colorado will soon allow out-of-state clinicians to provide telehealth to Colorado clients under a registration model starting in 2026. Until then, a full Colorado license is required to serve Colorado-based clients.
Source: CCHP Colorado
Connecticut
Connecticut temporarily allowed out-of-state mental health providers to register for telehealth practice during the COVID-19 period, but that provision expired in 2025. Clinicians should now obtain a Connecticut license to see clients there.
Source: CCHP Connecticut
Delaware
Therapists providing telehealth to clients in Delaware must hold a Delaware license or other recognized authorization. Standards of care and documentation requirements mirror those for in-person practice.
Source: CCHP Delaware
District of Columbia
If your client is located in D.C., you need a D.C. license or authorization to provide teletherapy. The same professional and ethical obligations apply as they would for face-to-face sessions.
Source: CCHP District of Columbia
Florida
Florida permits out-of-state providers to offer telehealth if they register as out-of-state telehealth providers and meet conditions such as liability coverage and good standing. Florida licensees do not need to register separately.
Sources: FL Health Telehealth | Florida Mental Health Professions Board
Georgia
Therapists must be licensed or otherwise authorized in Georgia to see clients located there. Georgia participates in several professional compacts that may simplify interstate practice.
Source: CCHP Georgia
Hawaii
Hawaii requires mental health providers to hold a Hawaii license to practice telehealth with clients located in the state. Verify with your profession’s board for any compact participation.
Source: CCHP Hawaii
Idaho
Therapists must be licensed in Idaho to see Idaho clients via telehealth. The state allows teletherapy within scope and applies the same confidentiality and recordkeeping standards as in-person sessions.
Source: CCHP Idaho
Illinois
Therapy delivered to clients physically located in Illinois requires an Illinois license. The Illinois Department of Financial and Professional Regulation (IDFPR) enforces these rules across all behavioral health professions.
Source: CCHP Illinois
Indiana
Indiana requires a valid in-state license to provide teletherapy to clients located within its borders. Telehealth sessions must comply with the same professional and documentation standards as in-person care.
Source: CCHP Indiana
Iowa
Clinicians must hold an Iowa license to practice with Iowa-based clients, whether in person or by telehealth. Professional standards and supervision rules remain the same.
Source: CCHP Iowa
Kansas
Therapists working with Kansas clients via telehealth must be licensed in Kansas. All the same ethical and recordkeeping standards apply.
Source: CCHP Kansas
Kentucky
To practice telehealth with clients located in Kentucky, you need a Kentucky license or participation in a recognized compact. Telehealth services are regulated under the same standards as in-person care.
Source: CCHP Kentucky
Louisiana
Therapists serving clients in Louisiana must be licensed or registered with the state. Louisiana requires compliance with all telehealth-specific consent and documentation standards.
Source: CCHP Louisiana
Maine
Maine requires authorization to serve Maine-based clients via telehealth, but the state is generally supportive of remote practice. Check your board for compact participation.
Source: CCHP Maine
Maryland
Therapists must hold a Maryland license to provide telehealth to clients located in Maryland. The same professional and ethical standards apply.
Source: CCHP Maryland
Massachusetts
To treat clients located in Massachusetts, therapists need Massachusetts authorization. Participation in MassHealth or other programs also requires state licensure.
Source: CCHP Massachusetts
Michigan
Therapists must be licensed in Michigan to treat Michigan-based clients via telehealth. The same consent, documentation, and emergency planning standards apply.
Source: CCHP Michigan
Minnesota
A Minnesota license (or compact participation) is required to provide teletherapy to clients in Minnesota. The state recognizes telehealth as equivalent to in-person practice for legal and ethical purposes.
Source: CCHP Minnesota
Mississippi
Mississippi requires therapists to be licensed or otherwise authorized to provide teletherapy to clients in the state. Compact participation may apply for some professions.
Source: CCHP Mississippi
Missouri
If your client is physically in Missouri, you must hold a Missouri license to provide therapy. Missouri’s telehealth standards mirror those for in-person practice.
Source: CCHP Missouri
Montana
Therapists must hold Montana authorization to treat Montana-based clients. Confirm details with your professional licensing board.
Source: CCHP Montana
Nebraska
A Nebraska license is required to provide teletherapy to clients in Nebraska. Standards of care are the same as in-person services.
Source: CCHP Nebraska
Nevada
Therapists must be licensed in Nevada to provide teletherapy to clients located there. Nevada applies identical standards to in-person and telehealth sessions.
Source: CCHP Nevada
New Hampshire
Therapists must be licensed in New Hampshire to see NH-based clients via telehealth. Limited consultation exceptions may exist for certain disciplines.
Source: CCHP New Hampshire
New Jersey
New Jersey requires a state license to serve clients located in NJ. Providers offering telehealth through an organization must also comply with NJ’s telemedicine registry requirements.
Sources: CCHP New Jersey | NJ DOH Registry
New Mexico
Therapists providing services to clients located in New Mexico must hold NM licensure or participate in a compact where applicable.
Source: CCHP New Mexico
New York
Therapists treating clients in New York must be authorized under NY law. NY OMH and Office of Professions publish detailed telehealth guidance for both private and program-based providers.
Sources: OMH Telehealth | NYS Office of the Professions
North Carolina
Therapists must hold North Carolina authorization to see NC-based clients via telehealth. Boards apply the same standards of care and confidentiality as in-person work.
Source: CCHP North Carolina
North Dakota
Therapists providing telehealth to clients located in North Dakota must be licensed in ND. Compact participation may offer a simplified path for some professions.
Source: CCHP North Dakota
Ohio
Ohio law requires therapists to hold an Ohio license when serving clients located in the state, even by telehealth.
Source: CCHP Ohio
Oklahoma
Therapists must be licensed in Oklahoma to treat clients located in Oklahoma through telehealth.
Source: CCHP Oklahoma
Oregon
Oregon requires therapists to hold Oregon licensure or another authorized pathway to treat clients physically located in Oregon.
Source: CCHP Oregon
Pennsylvania
To provide telehealth to clients in Pennsylvania, therapists must be licensed in Pennsylvania. The Department of State provides additional telemedicine FAQs.
Sources: CCHP Pennsylvania | PA Telemedicine FAQs
Rhode Island
Therapists must hold Rhode Island authorization to provide teletherapy to RI-based clients.
Source: CCHP Rhode Island
South Carolina
Therapists serving clients located in South Carolina must be licensed in SC. Telehealth services are held to the same standards as in-person care.
Source: CCHP South Carolina
South Dakota
Therapists must be licensed in South Dakota to provide telehealth to SD-based clients. Compact membership may simplify multistate practice.
Source: CCHP South Dakota
Tennessee
Tennessee requires therapists to hold Tennessee authorization when providing telehealth to TN-based clients.
Source: CCHP Tennessee
Texas
Therapists must hold a Texas license to provide teletherapy to clients located in Texas. If the client is in another state, both states’ rules must be followed.
Source: CCHP Texas
Utah
Clinicians serving clients located in Utah by telehealth must hold a Utah license or be authorized through a compact.
Source: CCHP Utah
Vermont
Vermont offers a telehealth license that allows out-of-state professionals to provide telehealth to a limited number of Vermont clients, under specific conditions.
Source: CCHP Vermont
Virginia
Therapists must be licensed or registered in Virginia to provide telehealth to VA-based clients. Virginia also participates in multiple professional compacts.
Sources: CCHP Virginia | eHealth Virginia
Washington
Therapists may apply for a probationary or reciprocity license to practice in Washington while completing full requirements. Telehealth follows the same standards as in-person sessions.
Source: CCHP Washington
West Virginia
Therapists who wish to serve clients located in West Virginia must hold West Virginia licensure or an approved compact credential.
Source: CCHP West Virginia
Wisconsin
Therapists must be licensed in Wisconsin to treat clients located in Wisconsin by telehealth. The same standards of care and documentation apply.
Source: CCHP Wisconsin
Wyoming
Therapists serving Wyoming clients via telehealth must hold a Wyoming license or authorization. Telehealth standards are equivalent to in-person care.
Source: CCHP Wyoming
National References
• HHS Telehealth – Licensing Across State Lines: https://telehealth.hhs.gov/licensure/licensing-across-state-lines
• CCHP Policy Finder – Cross-State Licensing & Telehealth Tracker: https://www.cchpca.org/all-telehealth-policies/
• PSYPACT: https://psypact.org/
• Counseling Compact: https://counselingcompact.org/map/
• Social Work Licensure Compact: https://swcompact.org/
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